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Registration form
Personal Information
Name
Birth Date
     
Address
City
State
Zip Code
Country
Phone (H)
Phone (W)
Email
Emergency Contact Information

Flight Information
I don't have my flights yet.
OR
Airline
Flight Number
Arrival Date
     
Arrival Time   
Departure Flight Number
Departure Date
     
Departure Time   

Accomodations
  Double
Single
Roommate request

Medical Conditions
Please list any medical conditions or allergies that we should know about.

Tours
While at the Volcano
Choose
(1 out of 3)
Whitewater rafting
Hanging Bridges
Canyoning
While at the beach
Choose
(2 out of 4)
Horseback Riding Adventure (Day 5)
Adrenaline - Filled Ziplinig (Day 5)
Half-day Ziplining Adventure (Day 6)
Pacific Snorkeling Catamaran Tour (Day 6)

Payment options
Enclosed is my full payment ($2,490)
Enclosed is my single supplement full payment ($3,145)

Credit Card information
Charge my
Visa
Mastercard
American Express
Discover
 
Card Number
Expiration Date
*Credit card charges are processed through our bank in Costa Rica and a 'foreign transaction fee' may be assessed by the bank that issued the credit card.

Liability Release and Assumption of Risk Agreement
Please read the next document

Liability Release and Assumption of Risk.pdf
I have carefully read this agreement. I understand that it is a release of liability and a contract between me and Adventure Travel, LLC. and/or its affiliated organizations, and I sign this agreement of my own free will. If any part of this agreement is deemed unenforceable, all other parts shall be given full force and effect.
Terms and Conditions

Signature
I've read, understand and agree to abide by all terms and conditions set forth by Adventure Travel, LLC. I authorize Adventure Travel LLC to charge my card in the amount stated above.
Name  
Memorable Costa Rica. 9 Hastings Circle, Rockville, MD 20850
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